Q: My 80-year-old father was fully independent before a sudden onset of neurological problems. He was hospitalized and his issues were managed with medication.

He was discharged to rehabilitation where he progressively deteriorated. After a week in rehab he was hospitalized again. All tests performed were negative and the doctors stated that they don't know what else to do.

Would a major medical center like those at Yale University or New York University offer additional multi-disciplinary attention that may prove beneficial? Since Western medicine is failing us, are there nontraditional treatments that we should explore? If so, how can we access them while he is in a community hospital?

Carolyn

A: I would like to address issues brought up by Carolyn in a broader sense applicable to all of us. Why does a very healthy senior get really ill quickly? Why does it happen to so many of us?

I suppose this has to do with what we geriatricians call "very low functional reserve." It means that when Carolyn's father was functioning well, he was operating at 99.9 percent of his capacity without any extra energy to spare in case of an illness. This is why he deteriorated so fast.

Can anything be done to help replenish our functional reserve, which does diminish as we age? Regular physical activity is one thing that can prove extremely beneficial here. It is never too late to start being active.

Other ways to shore up your functional reserve include avoiding stress and being faithful to whatever medications you are supposed to be taking.

How about seeking alternative treatments?

I firmly believe that there are only two types of interventions -- proven and unproven.

Homeopathy, which relies on using "natural" substances in miniscule doses, and bone manipulation practiced by doctors of osteopathy can sometimes help but I would not hold my hopes high.

After all, both the homeopathic approach and manipulation are not proven to work with the presentation Carolyn's dad has.

As to her question about taking her father to a larger academic center, the expertise may be there, but all doctors these days have access to most of the same information.

I am not sure about the advantage here although I would not discard this option.

Here is what I think Carolyn should do. First, she should find a physician she and her family trust, preferably someone who knows her dad well. They should ask questions. They can ask about consulting with a large academic center, and seek out a second or even third opinion.

If you are not satisfied, let the doctor know.

As far as where your dad should live, getting him home with (if possible) 24-hour supervision may be the way to go. Physical therapy can be done at home and this may give your dad the best chance of improving.

Do not give up hope but also be realistic. Remember that aggressive investigation and treatment can bring with it suffering. Most people do not want to suffer. Be careful.